MEDICARE: LARIS WAYNE MILLIGAN D.M.D., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4095	NC

General Provider Information

NPI Number	:	1942348891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARIS WAYNE MILLIGAN D.M.D., M.S.

Provider Business Mailing Address
First Line	:	2250 SHIPYARD BLVD STE 6
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-799-5000
Fax Number	:	910-799-2005

Provider Business Practice Location Address
First Line	:	2250 SHIPYARD BLVD STE 6
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-8070
Country	:	US
Telephone Number	:	910-799-5000
Fax Number	:	910-799-2005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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